Book reviews

This book is a collection of papers presented at the international symposium on the physio-pathology of sleep in Lyon in 1965. The studies are an outgrowth of the remarkable discovery by Aserinsky and Kleitman in 1953, of the two distinct eye movement patterns during sleep: the rapid eye movement (REM) phase, and a slow pendular (NREM) phase. Among the 20 essays of which this book is composed, Benoit's study indicated the increased electrical activity in the cat's lateral geniculate body during REM, as compared to the NREM phase. JouvetMounier's experiments, also with tie cat, showed that the animal in REM phase is relatively resistant to the effects of barbituates, as compared to those in NREM. Brebbia and Altschuler present evidence that there is an increase in oxygen intake by the human organism during REM. Using Valium (20-40 mg) and Reserpine (4-5 mg), Tissot and Ajuriaguerra increased the duration of REM in man. In human neonates, REM sleep accounts for 50% or more of the total time spent in sleep. Petre-Quadens, studying the newborn, noted the appearance of the smile during REM, about 3 months before the maternally-induced smile is evident. Interestingly, once the latter occurs, REM smile becomes reduced in frequency. Fishgold et al presented EEG tracings of the "dreamy" state in which hypnagogic images were reported. Disturbed REM patterns were found in studies with certain types of psychiatric disorders, Lairy reported.

In our Review of Dr. Moseley's book, we were willing to believe that the Doctor was amusing himself with a playfulness, which, however entertaining to his readers, we did not think becoming'the gravity of his profession, or the high importance of the subject. Mr. MerrimaU has taken the laudable pains of enquiring closer inty the facts on which Dr. Moseley has built his arguments, and finds a most inexcusable inattention, or something worse, in the manner in which he has collected his intelligence, or related it when collected.
As Mr. Merriman observes, we should be not less thankful to those who would furnish us with well attested facts, whether in favor of or against vaccination : But to those, whose only object is to cavil where they cannot refute, who look only for exceptions to invalidate a general law, who are regardless of the source's from which Mr. Merrimaris Observations \m Vaccine Inoculation. 173 they draw their intelligence, who not only joke on grave subjects, and substitute these jokes for arguments, but, in these festive moments, thunder forth anathemas of lameness, blindness, and deformity, against such as are vaccinated, and accusations of child murder against those whose children have died or may hereafter die at any period after vaccination ; to such we.can make no appeal, but trust that truth will in the end find her place, and only lament the mischiefs, that must follow while she is concealed.
We highly approve Mr. Merriman's industry, candour, and firmness, and recommend such of our readers as have been staggered by the boldness with which Dr. Moseley produces his supposed facts, carefully to peruse the pamphlet beforeus.
We think, however, that Mr. Merriman's note on Mr. Goldson might have been spared. It would have been enough to state, that vaccination was supported by the fi st medical characters; and tho' we agree with our author, in admitting the absurdity of supposing that the most eminent of the profession could be affected by th? insinuations of a few zealous partisans, yet we are convinced that the ill judged importunities of these zealots prevented the cordial co-operation of many honest, considerate, and well informed practitioners. We trust, however, good sense and candour are gradually gaining ground, and for that reason only we wish to hear as little as possible of Mr. Goldson and his pdversaries. As Dr. Moseley advances boldly with his cases, we feel duly sensible of the gratitude we owe to those who inquire into his statements ; and as to his mode of reasoning, the best refutation would perhaps be, to quote his own words almost without a comment.
Mr. Rogers being more modest, might be treated with more delicacy ; and as he is much younger, his future improvement is not altogether hopeless.* Besides which, we have no reason to suspect Mr. Rogers's willingness to procure every information, though he may sometimes trust too implicitly to the authority from which he derives his accounts. We shall conclude with a few extracts, addressed to each of these gentlemen. The first is very judiciously elected by Mr. Merriman from Dr. Woodr ville's History of Inoculation, where it is produced among the causes which lor a time impeded the progress of inoculation. " Dr. Deering, at Nottingham, whose opposition to inoculation a little boy,* who, notwithstanding the great care there was talcen in the choice of the pus, had the confluent kind, severely, and twelve months after had them naturally, and the favourable 'sort, yet was ?very full; when I met with many, and among them three in one family, miserably seamed and pitten; when it was known in several parts of London, that some of the inoculated persons had lost their lives; I could not help fearing these things might do that method harm, as they contradicted the sanguine promises of some of the favourers of that operation. " It has been insinuated, particularly by Mr. Rogers, a pupil of Mr. Birch, who has published a small pamphlet against vaccination, that no mention has ever been made, till lately, of the small-pox occurring a second time; t when so many objections ?were made to inoculation for half a century, surely if this liad ever occurred, the enemies to the practice would not have been silent on the subject; yet we know of no such instance (till now) brought forward/ " Had Mr. Rogers taken the pains of enquiring before he so confidently asserted, he would have found, besides the above case in Dr. Woodville's History of Inoculation, several such instances mentioned among the early opposers of variolation. Indeed, the insecurity of inoculation for preserving from variolous contagion was more dwelt upon than any other objection, and this not only at the introduction of the practice, but even so late as the year 1767.
" Of this kind was the case of the Dutchess of Boufflers, inoculated in the year 176'3, by M. Gatti, physician to the King of France, an inoculator of great experience, and one of the most eminent physicians in Paris. There is no reason to doubt, that she was inoculated with genuine variolous virus; and though the circumstances which are recorded of the progress of the inoculation are not sufficiently exact to satisfy us, that she passed properly through that process, yet they were so satisfactory to M. Gatti, that he repeatedly assured the Dutchess she had nothing to fear from the small-pox. Some time afterwards, however, she had the small-pox by casual infection, and M., Gatti rather lamely attempts to account for it, by acknowledging that the opinion he formed was inaccurate. The case, more at large, which is very deserving of attention, may be seen in the Gentleman's Magazine for 1765, p. 495. " There remain for consideration those cases of eruption consequent to inoculation with variolous virus, after the patient has gone through the cow-pox; these have been very unfairly called ' Cases of Small-pox after Vaccination/ I say unfairly, because it hasbeen long known, that inoculation with small-pox matter will produce the same kind of eruption on those who have before had the; small-pox, whether naturally or artificially. A case of this kind . was, * This boy was the son of Dr. Croft, and inpoulated by Dr. Steigerthal* ?iijsii?ian iu ordinary to King George I. Xv&s published so long rtgo as the year 1?22, by Dr. Wagstaffe, which occurred in St. Thomas Hospital. Mr. Tanner, the surgeon to that hospital, inoculated a person who had undergone the natural small-pox some years before. . Dr. Wagstaffe. who was a man ?f extensive practice, and physician to St. Bartholomews Hospital, affirms, that the eruptions on him appeared rather more fairly than in those (the criminals) who were inoculated.in Newgate; and he attended the whole progress of the disease in both instances. Had the practice of re-inoculating variolous patents prevailed in the same degree as it is employed at present with vaccinated ones, similar result? would, no doubt, have been oftener noticed " It is well known, that mothers and nurses have been repeat* edly infected from suckling and nursing children under a heavy load of small-pox pustules; and such persons have sometime? suffered very severely from fever, &c. before the eruption appeared.
" Experiments have been made to determine, whether the smallpox could be propagated by inoculating persons with the matter of such eruptions, and these experiments were perfectly decisive in ascertaining, that the genuine variola was produced. The fact is, therefore, absolutely established, that those who have gone thro' the small-pox are equally liable to be locally affected as those who have been vaccinated. It", then, in the one instance these are not called cases of small-pox, after small-pox, it is unfair to call the others cases of small-pox alter vaccination." Mr. Merriman justifies his expression in saying that they are unfairly called such ; by showing, that when it was the custom to make experiments of inoculating persons who had previously gone through the small-pox, the same eruptions sometimes occurred, and matter taken from them produced the disease.
The following remarks on some of Dr. Moseley's cases are given, that the reader may judge what credit we may attach to the rest. " ' Richard Curling, aged nesrly six years, son of Mr. Curling, No. IS, George Street, Portland Chapel, had the cow-pox in May 1800; inoculated by Mr. Ring, apothecary, in Swallow Street, Hanover Square. Nine months after he had the small-pox in the natural way, he had ulcerations about his body, and was otherwise much disordered after the cow-pox.' -" Having some previous knowledge of Mrs. Curling, I determined to call on her, and learn the particulars from herself. I "as accompanied by my friend Mr. Henning, surgeon, of Newman Street, who can vouch for the truth of the following statement.
" On being informed, that we were desirous of making enquiries respecting a child of hers, who Was said, in a publication of Dr.
Moseley's, to have had the small-pox after ^>cixig vaccinated, she expressed a readiness to give all the information in her powei ; ana the replies which she made to the questions put to her, were given 111 f( and proper manner. ,V'ey vvere in substance as follow: that some months after, the exact time she cannot recollect, he had, what she thought, the snialUpox. That she shewed the child, whilst under the eruption, to Mr. Leightqny surgeon* of Welbeck Street, and Mr. Draper, apothecary, of Bulstrode Street, Mnryle-bone ; who both declared that the eruption was the chicken-pox ; that they both saw it when it was at or near the height; that Dr. Moseley did not see the child during the time of the eruption, nor did any other medical man, except those abovementioned ; that a gentleman, who she supposes was Dr. Moseley* came to her about two or three months ago, and enquired if her child had not had the small-pox after vaccination, to which she replied she thought he had; and Dr. Moseley,. without making any enquiry into particulars, said, there was no doubt about it. She.further said, that the eruption continued out only a few days, she is positive not a week, and she believes the eruption was dried away at the end of five days at the farthest.
" The other case, if it can be called a case of variolous eruption after the cow-pox, occurred in a little boy, son of Mr. Johnson, No. l6, South Molton Street, whom I vaccinated about two years ago, entirely to my own satisfaction. Mr. Johnson has lately had a younger child inoculated with variolous virus, by Mr. Hyde. This child Lad the disease very plentifully, during which time the hoy, who had undergone vaccination, was continually with her. In the evening of Saturday, June 22, a few pimples came out on him. On the Tuesday following, before three days had elapsed, they were completely dried away* as my friend,, Mr. Scares, surgeon, of Half Moon Street, can testily. Four or five more pimples afterwards made an appearance, and as quickly disappeared.
" An opportunity has likewise been afforded me, of pointing out another erroneous report which Dr. Moseley has given circulation to, in his Treatise, p. 135; he there says, that the elder son d Mr. Eiigle-field, of Kentish Town, who had been vaccinated by Mr. Sandys,-4 soort after the inoculation, broke out in violent ulcerations, and died in a miserable manner.' " I am authorised by-Mr. Sandys to contradict this report. He stated to me expressly, that the elder chvhl, as well as his brother, recovered perfectly from the vaccination.; that a slight eruption on the skin, altogether distinct from and independant of the cow-pox,, afterwards appeared, but that there was' nothing at all uncommon or alarming in this eruption; that about three months after being vaccinated, the eldest son. was attacked with a peripneumony, of which he died." We shall make no other remark than, that how entertaining so ever his mode oj reasoning and collecting facts may be to Dr. Moseley, we wish him to recollect the table of the frogs v.ho perished fur the amusement oi school boys. The first part of this little tract contains an account of a polypus so large and so peculiarly situated, that the author found it necessary to remove them in a different manner from what is usual.
One was removed from the nose by excision, the other from behind the velum pendulum by the forceps. The instruments and diseases are well illustrated by the engravings, find very satisfactorily described. Many practical remarks are added, and also proposed improvements in the operation, under certain circumstances.
The improved instrument for the fistula is attached to the case before given to the public in our Journal; some further alterations are suggested.
Dr. Jackson, on the Treatment of Fevers.
( Continued from our last, pp. 85. ?97. ) The manner in which Dr. J. employs his chief remedy, the Bath, is detailed in the following extract.
" When the condition of body, under which cold bathing acts with effect, has been prepared by previous bleeding, by emetics, by purges, or by other means; so that congestion in the. venous system is removed, and that the pores of the skin are opened ; or when congestion in the biliary system and derangements of the alimentary canal, consequences of the direct action of the morbid cause, have been changed or affected in their conditions ; the surface of the body being then warmed by the air of an heated apartment, the skin stimulated by frictions, and animated by ?warm bathing; in short, when the whole moving poweis have been placed upon a ticklish balance, the affusion of cold water upon the naked body,?upon the head and shoulders, in the manner of a shower bath, produces a strong effect; it then ordinarily produces its own action, which is analogous to that of health. The effect is indicated, as the act is usually followed by a full, strong, a free and expanding pulse,?frequently by a copious perspiration, by a sound and refreshing sleep, and by a sweet sensation of comfort in all th? feelings. It is desirable in conducting this process,, that the degree of cold be as near that of freezing as possible ; it is essential, that the water be pure,?fresh irora the spring or fountain, and that the affusion be continued, tih marks are evident, that an impression is made upon the cuculation. If cg'ect be not decidedly attained by the first application, it will be proper to allow the patient, after he has been jyj 2 rubbed in every fever, nor in every circumstance of the same fever. It sometimes happens, and it is vulgarly known, that slight febrile indispositions are turnedoff in the beginning, by exercises in the open air, more severe than usual., or longer continued ; but though this fact has been often observed, yet it must, at the same time, he remembered, that the commencement of fever is not usua y the period in which the great benefits of this remedy are to be expected. The period at which the salutary effect is most certain, is the point of time when the circle of the diseased motions is completed, or nearly completed; that is, when a product of diseased action has been effected, or an office performed, in consequence of which the machine becomes again sensible to the impressions of ordinary causes. This, according to circumstances, may happen after the third day ; but it rarely happens till after the fifth or seventh. A circle of febrile movement is generally completed at these periods. Hence the stimulation of pure air, or rather a succession and forcible impression of pure .air, in consequence of progression, solicits the moving principle of rhe animal machine to resume its usual action, or, the rhythm of movement in which health consists. Health is thus established : But if this cause,?the common stimulant of life, be not applied at this period with some degree of force, a new circlc of diseased action is probably put in motion,?runs over another course, produces another product, similar to the former ; or it varies its product, according to the variety of circumstances by which it may be-acted upon. Ilence it is in fact, as it might be expected to be in reason, that the period fo.r the effectual employment of this remedy, is more peculiarly that point of time when the diseased movement has completed the circle of its course ; or that condition under which the diseased movements have.been arrested artificially, by the effects of bleeding, of emetics, purgatives, or other means. 44 It is to be remarked, that the act of transporting persons in the early stage of -fever, with signs of plethora, is not beneficial ; it is not useful, or even safe, where there exist, with such fever, signs of inflammation in the internal organs,?the head, heart, lungs, liver, or intestines. The same means, on the contrary, are followed by the most signal and decided relief, where there are signs of congestion in secreting organs ; as in the bilious or ardent fever, attended with great anxiety., with burning heat, restlessness, want of sleep ; in short, with all the aggravated symptoms usual in the bilious autumnal fever of hot countries.. It is in this form of disease, that its good effects were so conspicuous in the campaigns in the southern provinces of America: the rule holds equally in tropical climates. It is the last ant hoi of hope, in the late stages of the concentrated endemic, to which Europeans are liable soon after their arrival in the West Indies, a disease, which may be cut short in the commencement, with .id[nost a positive certainty ; but -which, when left to itself, very generally generally tends to destruction, degenerating into what is called yellow'fever, with black vomiting, and all its formidable train of symptoms. " In this situation of things, (certainly a hopeless one, for the susceptibility of impression is nearly lost,) the act of moving the body rapidly, in an open cart, or carriage, through woods", on the green turf; or in defect of woods, shaded, if in the day time, with boughs of trees ; exposed, if in the night time, to all the freshness of the air, and all the dews of heaven, has appeared to do what no other means were capable of doing. The effect of this practice will be rendered more certain by previously taking away some blood, in relief of the congestion which has already taken place in the venous system; by sprinkling the body occasionally with the coldest water that can be procured ; by moving at a brisk pace?even over unequal ground ; by occasionally repeating the sprinkling with water ; by opening the vein a second, or even a third time : in short, by adopting and persisting in such a train of processes, *is not only originate a new movement, but as confirm it when begun. It, is vain to expect that this can be effected in a short time, that is, in less than six or eight hours: lience it happens, as might be expected, that this remedy, when ordered by design, often fails ; because the operation is not continued a sufficient length of time: when adopted from necessity, it often succeeds ; for the operation is continued till the effect is confirmed.